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Use of sedation in children receiving computed tomography after head injuries
Tammy Goldwasser1, Silvia Bressan, Ed Oakley
1aEmergency Department, Royal Children's Hospital Melbourne bEmergency Research Group, Murdoch Childrens Research Institute cDepartment of Paediatrics, University of Melbourne dNational Trauma Research Institute, Melbourne, Victoria, Australia eUniversity of Padova, Padova, Italy.
Insights
Procedural sedation for pediatric head trauma computed tomography of the brain (CTB) is infrequent. Younger children (under 5 years) are significantly more likely to receive sedation for CTB than older children.
Area of Science:
- Pediatric Emergency Medicine
- Neuroimaging
- Sedation Anesthesia
Background:
- Head trauma is a common reason for pediatric brain computed tomography (CTB).
- Procedural sedation is sometimes used to facilitate CTB in children.
- Understanding sedation patterns is crucial for managing pediatric head injuries.
Purpose of the Study:
- To determine the utilization of procedural sedation for head trauma-related CTB in children.
- To investigate the association between sedation use, patient age, and Glasgow Coma Scale (GCS) scores.
Main Methods:
- Retrospective chart review of children undergoing CTB for head injury at a tertiary pediatric emergency department.
- Data collection included demographics, GCS scores, sedation characteristics, and adverse events.
- Analysis focused on sedation rates in relation to age and GCS.
Main Results:
- Of 442 eligible children, 6.3% received procedural sedation for CTB.
- Sedation rates were significantly higher in children younger than 5 years (18.4%) compared to those 5 years or older (1.0%).
- No significant association was found between sedation use and initial GCS scores (GCS ≤ 12 vs. > 12).
Conclusions:
- Procedural sedation for CTB in pediatric head trauma patients is infrequently utilized.
- Younger children (< 5 years) represent a demographic significantly more likely to receive sedation for CTB.
- These findings aid in assessing risks and resource allocation for CTB in pediatric head injury cases.
Objective:
The aim of this study was to determine the use of procedural sedation for head trauma-related computed tomography of the brain (CTB) in children and its association with age and Glasgow Coma Scale (GCS) scores.
Patients And Methods:
A retrospective review was carried out of charts of children undergoing a CTB for head injury at a tertiary paediatric emergency department with an annual census of 82 000 over a 2-year period. Patients were identified through the database of an ongoing prospective study involving children with head injuries of all severity. We extracted demographics, GCS scores, characteristics of sedation used for CTBs and adverse events.
Results:
In total, 477 patients underwent CTB after head injury. Thirty-three were intubated for medical management of severe head injury and two received midazolam for seizure management. Of the remaining 442, 67.4% were male and their mean age was 8.3 years. 30.8% had abnormal CTBs and 2.0% required neurosurgery. Twenty-eight [6.3%, 95% confidence interval (CI) 4.2-9.0] were sedated for CTB including 10 who initially failed CTB without sedation. Two patients were intubated for CTB. The sedation rate was 18.4% in patients less than 5 years versus 1.0% in children of age 5 years or more [odds ratio (OR) 22.8, 95% CI 6.7-119.1, P<0.001]. The sedation rate was 3.7% in patients with initial GCS 12 or less versus 10.2% in children with GCS more than 12 (OR 0.34, 95% CI 0.1-2.2, P=0.27).
Conclusion:
Children with head injuries who require CTB are infrequently sedated. Younger children are more likely to receive sedation. These data will be useful for the assessment of CTB-associated risks.
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